Maternal Cardiovascular Health Tied To CVD Risk In Adolescent Offspring

Children born to mothers with better cardiovascular health at 28 weeks' gestation are likely to also have low cardiovascular risk for their age by early adolescence, a new study suggests.

Researchers examined data on 2,302 mother-child dyads. The mothers (mean age, 29.6 years) had a mean cardiovascular health score of 8.6 out of 10 based on five metrics: blood pressure, BMI, glucose level, smoking, and total cholesterol level. Each metric was set as ideal, intermediate, or poor based on pregnancy health guidelines.

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Overall, 32.8% of mothers had all-ideal cardiovascular health metrics, and 6.0% had all-poor metrics.

Compared to offspring of mothers with all-ideal metrics, youth whose mothers had two or more poor metrics were significantly more likely to have one poor metric (adjusted relative risk 2.02) or at least two poor metrics (aRR 7.82) when they were 10 to 14 years old (mean, 11.3 years).

"We confirmed that these associations were not due to a single risk factor, such as obesity or diabetes," said lead study author Dr. Amanda Marma Perak, a pediatric preventive cardiologist at the Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine.

"All of the cardiovascular health metrics seemed to contribute to the associations," Dr. Perak said by email. "I think this emphasizes the importance of the total intrauterine cardiometabolic environment for the offspring's health, and highlights the potential power of using the cardiovascular health construct to characterize that environment."

Even mothers with one or more cardiovascular metrics that were intermediate instead of ideal had a significantly greater risk of offspring with one poor metric (aRR 1.17) or at least two poor metrics (aRR 2.15).

The study excluded mothers with pre-gestational diabetes, women with severe gestational diabetes, and preterm offspring, which may limit the generalizability of the results, the authors note in JAMA. The study also wasn't designed to determine how maternal cardiovascular health might impact outcomes for offspring.

"Presumably some of the effects of maternal health during pregnancy on the future health of offspring is related to ongoing shared lifestyle and underlying genetics, but there may be specific impact of nutrition to the fetus on metabolism that could have long lasting effects," said Dr. Stephen Daniels, chair of pediatrics at the University of Colorado School of Medicine, in Aurora, and pediatrician-in-chief at Children's Hospital Colorado, who wrote an editorial accompanying the study.

The study results suggest that women need pre-conception and prenatal care aimed at improving cardiovascular health, not only to help women have better health but also to improve outcomes for their children, Dr. Daniels said by email. Pediatricians should also monitor cardiovascular risk factors.

"It is really important for pediatricians and family physicians to work with children and their family to have a diet and level of physical activity that promotes optimum cardiovascular health," Dr. Daniels said. "It is never too late to work on this and the benefits are quite good both in the short and long term."

—Lisa Rapaport

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